Care Planning & Integrated Care - Western Sydney PHN, Australia

Demonstrates: Implementation of the LinkedEHR tool

Main outcome:

The improvement of care for patients across the Western Sydney region, with practical patient shared care planning solutions and a centralised repository for clinical data. Enables doctors, allied health professionals, hospitals and specialists to collaborate together in the care of patients complex and chronic problems.

Roll-out:

Phase one - delivered June, 2013

Phase two - delivered June, 2014

NSW integrated care component - live June, 2015 and continuing to be developed.

Overview:

The Australian Federal and State Governments are working together to improve the care of patients with chronic disease across the continuum of care. The aim of the integrated care project is to ensure better care for chronic conditions. Improved management of patients moving between primary and acute care is also an important focus, with the goal of preventing hospital re-admission.

Consumer registration for local eHealth services, including care team definition and MyEHR link

The ability to share care plans for clients with complex needs, enabling more efficient and timely interventions Enables doctors, allied health professionals, hospitals and specialists to collaborate together in the care of patients complex and chronic problems.

Integration across sectors of local health providers in primary care, local hospital services, State (NSW) Health services, and the My Health Record infrastructure

A longitudinal health record

The project covers:

150 GP clinics

150+ Allied health providers and groups

5 Public Hospitals

500,000+ patient population

Key Benefits:

Both patient and care provider benefit from streamlining communication and creating greater coordination of care.

Patient - Improved management of their chronic disease is combined with better input from care-givers. By being more engaged with their own care, patients are more likely to benefit from a comprehensive care plan.

GP - A reduction in time spent managing complex care plans with allied health providers, access to best practice guidelines, plus better information about their patients as they move around the system, means GPs are better able to improve consistency of care.

Allied Health - When allied health providers have better communication with GPs and other care-givers, efficiency of care improves.